Original Article

Supportive Care in Cancer

, Volume 21, Issue 7, pp 1879-1884

First online:

Use of cancer therapy at the end of life in patients with malignant pleural mesothelioma

  • Steven C. KaoAffiliated withAsbestos Diseases Research InstituteDepartment of Medical Oncology, Sydney Cancer CentreFaculty of Medicine, University of Sydney
  • , Nico van ZandwijkAffiliated withAsbestos Diseases Research InstituteFaculty of Medicine, University of Sydney
  • , Peter CorteAffiliated withDepartment of Respiratory Medicine, Royal Prince Alfred Hospital
  • , Christopher ClarkeAffiliated withAsbestos Diseases Research Institute
  • , Stephen ClarkeAffiliated withFaculty of Medicine, University of SydneyDepartment of Medical Oncology, Royal North Shore Hospital
  • , Janette VardyAffiliated withDepartment of Medical Oncology, Sydney Cancer CentreFaculty of Medicine, University of SydneyDepartment of Medical Oncology, Concord Repatriation General Hospital Email author 

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Abstract

Purpose

Malignant pleural mesothelioma (MPM) is considered a treatment-resistant disease. We determined the proportion of patients who received treatment in the last month of life and potential factors associated with use of chemotherapy at the end of life.

Methods

Consenting MPM patients compensated by the Dust Diseases Board (DDB) were included. Patient, treatment and outcome details were obtained through the DDB, treating physicians and Medicare Australia. The association between potential factors (age, gender, geographical location, disease stage, histological subtype, palliative care referral, length of first line chemotherapy and lines of treatment) and chemotherapy use in the last month of life was determined.

Results

A total of 147 MPM patients were included in the analysis: 78 received chemotherapy, 50 had radiotherapy and 116 had surgery (77 received more than one treatment modality whilst 56 received one treatment modality). Twenty-one patients received treatment in their last month of life: nine received chemotherapy; six, radiotherapy and six had surgery. Those who were treated with second or subsequent lines of chemotherapy were more at risk of receiving chemotherapy until the end of life (six of 19 patients, i.e., 32 %) compared to those who were only treated with first-line therapy (three of 59 patients, i.e., 5 %; p < 0.01). Patients who received chemotherapy at the end of life had shorter survival compared to those who did not receive chemotherapy at the end of life (5.3 vs. 12.5 months, respectively; p = 0.01).

Conclusions

Chemotherapy utilisation in the last month of life is not uncommon in this series of MPM patients. Patients who failed previous chemotherapy were more likely to receive chemotherapy near the end of life. More careful consideration of when to cease chemotherapy needs to be made as patients who received chemotherapy at the end of life had poorer survival outcome.

Keywords

Chemotherapy End of life Malignant pleural mesothelioma Radiotherapy Surgery Treatment utilisation